IVF/ICSI outcomes between cycles with luteal estradiol (E2) pre-treatment before GnRH antagonist protocol and standard long GnRH agonist protocol: a prospective and randomized study (original) (raw)

Abstract

Objective

To study if luteal E2 pre-treatment before GnRH antagonist protocol improves IVF/ICSI outcomes compared with standard long GnRH agonist protocol.

Design

A prospective, randomized and controlled study.

Setting

ART center of a state public hospital

Patient(s)

Two hundred twenty infertile women underwent IVF/ICSI treatments.

Intervention(s)

Participants received oral Estradiol Valerate 4 mg/day preceding the IVF cycle from day 21 until day 2 of next cycle before GnRH antagonist protocol (E2 pre-treatment group n = 109) or received standard long GnRH agonist protocol as control group (n = 111).

Main outcome measure(s)

Number of oocytes collected, MII oocytes, fertilization, implantation, live birth and early pregnancy rate, and hormone profiles.

Result(s)

E2 pre-treatment exerted a significant suppressive effect on FSH but not LH secretion compared with basal FSH and LH levels. In E2 pre-treatment group serum LH level was significantly higher during COH and serum P was also significantly higher on the day of HCG injection compared with control group. Five patients from E2 pre-treatment group had elevated LH at all time (≥10 IU/L) and also a concomitantly high P (>1 ng/mL). Two of the five women achieved pregnancy but had early pregnancy loss. Overall, IVF/ICSI outcomes such as implantation, clinical pregnancy and live birth rates were similar between E2 pre-treatment and control groups.

Conclusion(s)

Luteal E2 pre-treatment before GnRH antagonist protocol significantly increases serum LH level and incidence rate of premature LH but no significant effect is observed on implantation, clinical pregnancy, live birth and early pregnancy loss rates compared with long GnRH agonist protocol. However, more studies in large numbers of cycles are needed to confirm that increased serum LH level by E2 pre-treatment during COH has no negative effect on the IVF/ICSI outcomes.

Access this article

Log in via an institution

Subscribe and save

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

The alternative text for this image may have been generated using AI.

Similar content being viewed by others

References

  1. Al-lnany H, Aboulghar M. GnRH antagonist in assisted reproduction: a Cochcane review. Hum Reprod. 2002;17:874–85. doi:10.1093/humrep/17.4.874.
    Article Google Scholar
  2. Huirne JA, Homburg R, Lambalk CB. Are GnRH antagonists comparable to agonists for use in IVF? Hum Reprod. 2007;22:2805–13. doi:10.1093/humrep/dem270.
    Article PubMed CAS Google Scholar
  3. Devreker F, Pogonici E, De Maertelaer V, Revelard P, Vanden Bergh M, et al. Selection of good embryos for transfer depends on embryo cohort size: implication for the mila ovarian stimulation debate. Hum Reprod. 1999;14:3002–8. doi:10.1093/humrep/14.12.3002.
    Article PubMed CAS Google Scholar
  4. Opsahl MS, Blauor KL, Black SH, Lincoln SR, Thorell L, Sherins RJ. The number of embryos available for transfer predicts successful pregnancy outcome in women over 39 years with normal ovarian hormonal reserve testing. J Assist Reprod Genet. 2001;18:551–6. doi:10.1023/A:1011906024170.
    Article PubMed CAS Google Scholar
  5. Fanchin R, Cunha-Filho JS, Schonauer LM, Kadoch IJ, Cohen-Bacri P, Frydman R. Coordination of early antral follicles by luteal estradiol administration provides a basis for alternative controlled ovarian hyperstimulation. Fertil Steril. 2003;79:316–21. doi:10.1016/S0015-0282(02)04574-0.
    Article PubMed Google Scholar
  6. Fanchin R, Salomon L, Castelo-Branco A, Olivennes F, Frydman N, Frydman R. Luteal estradiol pre-treatment coordinates folliclar growth during controlled ovarian hyperstimulation with antagonist. Hum Reprod. 2003;18:2698–703. doi:10.1093/humrep/deg516.
    Article PubMed CAS Google Scholar
  7. Fanchin R, Cunha-Filho JS, Schonauer LM, Righini C, de Ziegler D, Frydman R. Luteal estradiol administration strengthens the relationship between day 3 follicle-stimulations hormone and inhibin B levels and ovarian follicular status. Fertil Steril. 2003;79:585–9. doi:10.1016/S0015-0282(02)04757-X.
    Article PubMed Google Scholar
  8. Chun SY, Eisenhauer KM, Minami S, Billig H, Perlas E, Hsueh AJ. Hormonal regulation of apoptosis in early antral follicles: follicle-stimulating hormone sa a major survival factor. Endocrinology. 1996;137:1447–56. doi:10.1210/en.137.4.1447.
    Article PubMed CAS Google Scholar
  9. Klein NA, Battaglia DE, Fujimoto VY, Davis GS, Bremner WJ, Soules MR. Reproductive aging: accelerated ovarian follicular development associated with a monotropic follicle-stimulating hormone rise in normal older women. J Clin Endocrinol Metab. 1996;81:1038–45. doi:10.1210/jc.81.3.1038.
    Article PubMed CAS Google Scholar
  10. Hillier SG, Van den Boogaard AM, Reichert LE Jr, Van Hall EV. Intraovarian sex steroia hormme interaction and the regulation of follicular maturation: aromatization of androgens by human granulose cells in vitro. J Clin Endocrinol Metab. 1980;50(4):640–7.
    Article PubMed CAS Google Scholar
  11. Durnerin-Cedrin I, Bstandig B, Parneix L, et al. Effects of oral comfraceptive, synthetic progestogen or natural estrogen pre-treatments on the hormonal profile and the antral follicle cohort before GnRH antagonist protocol. Hum Reprod. 2007;22:109–16. doi:10.1093/humrep/del340.
    Article CAS Google Scholar
  12. Laholu N, Chabbert-Buffer N, Christin-Maitre S, Le Nestour E, Roger M, Bouchard P. Main inhibitor of follicle stimulating hormone in the luteal-follicular transition: inhibin A, Destradios, or inhibin B? Hum Reprod. 1999;14:1190–3. doi:10.1093/humrep/14.5.1190.
    Article Google Scholar
  13. Borm G, Mannaerts B. Treatment with the gonadotrophin-releasing hormone antagonist ganirelix in women undergoing ovarian stimulation with recombinant follicle stimulating hormone in effective, safe and convenient: results of a controlled, randomize, multi-centre trial. The European Orgalutran Study Group. Hum Reprod. 2000;15:1490–8. doi:10.1093/humrep/15.7.1490.
    Article PubMed CAS Google Scholar
  14. Al-Inany H, Aboulghar M. GnRH antagonist in assisted reproduction: a Cochrane review. Hum Reprod. 2002;7:874–85.
    Article Google Scholar
  15. Huime JAF, van Loenen ACD, Schats R, McDonnell J, Hompes PGA, Schoemaker J, et al. Dose-finding study of daily GnRH antagonist for the prevention of premature LHsurges in IVF/ICSI patients: optimal changes in LH and progesterone for clinical pregnancy. Hum Reprod. 2005;20:359–67.
    Google Scholar
  16. Kolibianakis EM, Zikopoulous K, Schiettecatte J, Smita J, Tournaye H, Camus M, et al. Profound LH suppression after GnRH antagonist administration is associated with a significantly higher ongoing pregnancy rate in IVF. Hum Reprod. 2004;19:2490–6. doi:10.1093/humrep/deh471.
    Article PubMed CAS Google Scholar
  17. Rombauts L, Healy D, Norman RJ. A comparative randomized trial to assess the impact of oral contraceptive pretreatment on follicular growth and hormone profiles in GnRH antagonist-treated patients. On behalf of the Orgalutran Scheduling Study Group. Hum Reprod. 2006;21:95–103. doi:10.1093/humrep/dei302.
    Google Scholar
  18. Kolibianakis EM, Albano C, Kahn J, Camus M, Tournaye H, Van Steirteghem AC, et al. Exposure to high levels of luteinizing hormone and estradiol in the early follicular phase of gonadotropin-releasing hormone antagonist cycles is hv+mcnkjjassociatoal with a reduced chance of pregnancy. Fertil Steril. 2003;79:873–80. doi:10.1016/S0015-0282(02)04920-8.
    Article PubMed Google Scholar

Download references

Acknowledgement

The authors thank Dr. De Yi Liu from the University of Melbourne, Australia, for revising the final draft of the manuscript.

Author information

Authors and Affiliations

  1. Chongqing Reproductive and Genetic Institute, Chongqing Obstetric and Gynecology Hospital, 64 Jingtang St., Yuzhong District, Chongqing, 400013, China
    Hong Ye
  2. Chongqing Reproductive and Genetic Institute, Chongqing Obstetric and Gynecology Hospital, Chongqing, China
    Guo-ning Huang, Ping-hong Zeng & Li Pei

Authors

  1. Hong Ye
  2. Guo-ning Huang
  3. Ping-hong Zeng
  4. Li Pei

Corresponding author

Correspondence toHong Ye.

Rights and permissions

About this article

Cite this article

Ye, H., Huang, Gn., Zeng, Ph. et al. IVF/ICSI outcomes between cycles with luteal estradiol (E2) pre-treatment before GnRH antagonist protocol and standard long GnRH agonist protocol: a prospective and randomized study.J Assist Reprod Genet 26, 105–111 (2009). https://doi.org/10.1007/s10815-009-9300-3

Download citation

Keywords